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CORRECTION OF OUTWARDLY THE FROM EMIL The outwardly minimus patient drags is oie his stricken position further Dissatisfied a simple leg of the and effective Model Figure as an ISRAEL Labourer’s after-effect common of forward, Sick Fund, paralysis complications of Haifa the gluteus of poliomyelitis. and a statically troubled methods of treatment method to show 2-Forward HAIFA, Department, leg awkwardly aggravates with the Communication PAUKER, the Orthopaedic rotated muscles LEG POLIOMYELITIS Preliminary From ROTATED the femoral medius and In consequence head the in its unphysiological gait in a progressive fashion. used hitherto I have attempted to develop of correction. FIG. I the mechanism movement FIG. 2 of the transplant. Figure 1-Position of limb at rest. of limb. The graft under tension pulls the femur into medial rotation. Rotation arthrodesis of osteotomyof the hip, Transplantation part of but this the too function behind 70 under femur fails to align physiologically the useful in some respects, is a rather of the iliopsoas greater muscle trochanter is a rather of the Years the although formidable transplanted ago I tried the from (Mustard its insertion L952), may operation, and at the lesser provide trochanter a solution in addition whole of the leg, and crippling operation. to the in a number it severely impairs lateral of the cases, original muscle. to attachment dissect of a strip the vastus of the lateralis, iliotibial in tract and order to THE JOURNAL to rotate sling the OF BONE it forward femur AND from forward JOINT by SURGERY CORRECTION action weak of the tensor to move the longer capable OF THE OUTWARDLY ROTATED fasciae latae. This method whole leg. The answer was leverage with of providing the possible such action. avoidance are longitudinal identified. The incision POLIOMYELITIS against 71 lever apparently in a transplant gravity. The being too providing hamstrings seemed OPERATION is made semitendinosus FROM failed, the short therefore sought of action THE A medial LEG over the lower muscle, third of the femur. if available, The hamstrings is considered most suitable for transplant because of its long tendon. It is dissected up to the lower medial third of the femur, and the tendon is brought under the quadriceps (vastus and rectus) to the antero-lateral part ofthe femur about a small hand’s width above the kneejoint and threaded through a horizontal tunnel drilled from the lateral bone, or to the tendon itself muscle, or a combination equally suitable. When no medial behind the femur hamstring and fixed 3-Before medial aspect of the bone, where is available to the the medial biceps surface may of the be used, bone at the 3 FIG. Case 4. Figure to the its end is fixed to the at the point of entrance into the drill hole. The semimembranosus of more than one muscle from the medial hamstring group, its tendon same FIG. operation : lateral rotation deformity. Figure 4-Range being level. is passed If only one 4 of active medial rotation after operation. medial hamstring is available but the biceps patient in whom the semimembranosus-the transplantation the remaining strong biceps of knock-knee. Figures 1 and 2 show needed for medial rotation. the mechanism The femur, rotates improves muscles good a grading of 3 with to use the biceps. In one only acting medial hamstring-was used was thought to be responsible for the development of the transplant, and moved forward by active a swinging movement, automatically Every bit of active muscle power with I prefer is powerful indicate muscle how power little power or simply for is by medially by application of the one-sided brake.” and reinforces this movement. I have transplanted “ results. RESULTS The results in seven cases are shown in Table in Figures 3 and 4. In assessing the results the I, and term “ illustrative excellent “ photographs was used sway from the hip and with medial rotation of the leg possible with “Good” meant a swayless or nearly swayless gait, the foot coming while walking and medial rotation possible with the heel on the allowance VOL. 41 B, for NO. some 1, sway FEBRUARY from 1959 the hip, but less than before operation, for are reproduced a gait without the heel off the ground. down in good position ground. “Fair” gave the foot coming down 72 with E. PAUKER little or change from seven patients no lateral the rotation, condition but before subjected with no operation to this type active would of transplant number (yers) seventh from a poor four Transplant used Result Semitendinosus Good - 14 months Biceps Fair - 3 7 21 months 4 4 7 months 5 5 14 months was Semitendinosus Good Biceps Semitendinosus 36 months a woman of the knee re-education Semimembranosus of forty-seven of age; Complications 15 months 9 months Six of the years CASrs) (SEVEN 7 6 appreciable I RESULTS 5 47 of result. to seven I 7 arthrodesis very little fOIIW-Up AND Lack called 2 6 the DETAILS rotation. been ranged TABLE CLINICAL medial have who was Moderate knock Excellent - Excellent - Good - Good - operated upon for the same condition. It was remarkable in the use of the transplanted muscle. with that knee good result all the patients after an needed SUMMARY 1. A method of one of correcting poliomyelitic or more of the hamstring results in seven cases 2. The 3. Though it is emphasised number of patients mechanically and so treated physiologically muscles are that lateral rotation to the femur is described. deformity than a preliminary of the thigh by transplant recorded. this is small, sound. is no the more satisfactory results communication suggest that the and the procedure is REFERENCE MUSTARD, Surgery, W. T. (1952): 647. Iliopsoas Transfer for Weakness of the Hip Abductors. Journal of Bone and Joint 34-A, THE JOURNAL OF BONE AND JOINT SURGERY